Malaria N° 10 - Subject N° 4

USING COTRIMOXAZOLE TO TREAT CHILDHOOD UNCOMPLICATED MALARIA IN AN AREA WITH MULTI-DRUG RESISTANCE IN TANZANIA
T.K. Mutabingwa, A.M. Rønn, I.C. Bygbjerg, E.K. Maina and E. Hills

SUMMARY
The overlap in the clinical presentation and treatment of malaria and pneumonia led to the recommendation of cotrimoxazole (CTMZ) for concomitant treatment of both diseases. This may be limited by widespread antimicrobial drug resistance, and necessitating continuous monitoring of the chemotherapeutic efficacy of CTMZ. The efficacy of 5-days CTMZ at 20 mg/kg of sulphamethoxazole in two divided doses was evaluated in 100 under-fives suffering from uncomplicated malaria at Muheza Designated District Hospital. The district has multi-drug resistance. Another 100 under-fives, were treated with 25 mg chloroquine base/kg, given in three divided doses over three days (CQ). Both groups were comparable by age, pre-treatment parasite densities, and mean haemoglobin. All were admitted for 7days and followed on days 14, 21, 28. CTMZ cleared parasitaemia in 94% of patients by day 7 and CQ 14%. Mean parasite clearance times (MPCT) were 4.1 (CTMZ) and 5.6 (CQ) days. Resolution of symptoms by day 3 was 64% (CTMZ) and 41% (CQ). CTMZ had a high recrudescence rate of 18% by day 14. The MPCT for CTMZ is significantly higher than 2.6 days reported in 1975 (Muheza) and 2.7 days (Malawi) reported in 1991. The MPCT and recrudescence indicate increased tolerance of the parasites to CTMZ, the gateway to resistance. Limited and judicious use of CTMZ is essential to prolong its chemotherapeutic value. Chloroquine is an unsuitable first line antimalarial drug.